title: Progression of foot deformity in Charcot neuropathic osteoarthropathy.
abstract: BACKGROUND
  Charcot neuropathic osteoarthropathy associated foot deformity can result in joint instability, ulceration, and even amputation. The purpose of the present study was to follow patients with and without active Charcot osteoarthropathy for as long as two years to examine the magnitude and timing of foot alignment changes.
  
  
  METHODS
  We studied fifteen subjects with Charcot osteoarthropathy and nineteen subjects with diabetes mellitus and peripheral neuropathy without Charcot osteoarthropathy for one year; eight of the subjects with osteoarthropathy and five of the subjects with diabetes and peripheral neuropathy were followed for two years. Bilateral weight-bearing radiographs of the foot were made at baseline for all subjects, with repeat radiographs being made at six months for the osteoarthropathy group and at one and two years for both groups. Radiographic measurements included the Meary angle, cuboid height, calcaneal pitch, and hindfoot-forefoot angle.
  
  
  RESULTS
  The Meary angle, cuboid height, and calcaneal pitch worsened in feet with Charcot osteoarthropathy over one year as compared with the contralateral, uninvolved feet and feet in patients with diabetes and peripheral neuropathy. Cuboid height continued to worsen over the two-year follow-up in the feet with Charcot osteoarthropathy. These feet also had a greater change in the hindfoot-forefoot angle at one year as compared with the feet in patients with diabetes and peripheral neuropathy and at two years as compared with the contralateral, uninvolved feet.
  
  
  CONCLUSIONS
  In patients with Charcot neuropathic osteoarthropathy, radiographic alignment measurements demonstrate the presence of foot deformity at the time of the initial clinical presentation and evidence of progressive changes over the first and second years. The six-month data suggest worsening of medial column alignment prior to lateral column worsening. This radiographic evidence of worsening foot alignment over time supports the need for aggressive intervention (conservative bracing or surgical fixation) to attempt to prevent limb-threatening complications.
authors.affiliation: Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, Room 1101, St. Louis, MO 63108-2212, USA. hastingsmk@wustl.edu
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strube
authors.forename: Charles F
authors.initials: CF
authors.lastname: Hildebolt
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Bohnert
authors.forename: Fred W
authors.initials: FW
authors.lastname: Prior
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
mesh_terms: D000328:Adult; D001177:Arthropathy, Neurogenic / Q000145:classification / Q000150:complications* / Q000473:pathology; D017760:Bone Malalignment / Q000209:etiology; D003929:Diabetic Neuropathies / Q000150:complications; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000209:etiology*; D006801:Humans; D007103:Immobilization; D008297:Male; D013639:Tarsal Bones / Q000473:pathology